Belai Y, Goodwin T M, Durand M, Greenspoon J S, Paul R H, Walther F J
Department of Obstetrics and Gynecology, Los Angeles County, Medical Center, USA.
Am J Obstet Gynecol. 1998 Jan;178(1 Pt 1):13-9. doi: 10.1016/s0002-9378(98)70619-2.
In term infants umbilical cord gas analysis is a poor predictor of immediate newborn complications associated with intrapartum asphyxia, unless the umbilical arterial pH is less than 7.00. We investigated whether umbilical arteriovenous blood gas differences may better predict asphyxia-related complications.
The study population consisted of 82 term, nonanomalous, singleton, live-born infants with severe umbilical acidosis (pH < 7.00). Umbilical arteriovenous pH, PCO2, and PO2 differences were correlated with Apgar scores and the presence of seizures, hypoxic-ischemic encephalopathy, cardiopulmonary and renal dysfunction, and abnormal development in the neonatal period.
Umbilical arteriovenous pH, PCO2, and PO2 differences were interrelated (p < 0.0001), but these parameters correlated only weakly with 1-minute and 5-minute Apgar scores. An arteriovenous PCO2 difference > 25 torr was a highly sensitive and specific parameter in identifying asphyxiated infants with seizures, hypoxic-ischemic encephalopathy, cardiopulmonary and renal dysfunction, and abnormal development in the neonatal period. Arteriovenous PO2 differences were less sensitive in the detection of neonatal morbidity than arteriovenous PCO2 differences.
Umbilical cord blood arteriovenous PCO2 differences provide a new tool to predict neonatal morbidity and permanent neurologic injury in term infants with perinatal asphyxia.
对于足月儿，脐血气分析对预测与产时窒息相关的新生儿即刻并发症效果不佳，除非脐动脉血pH值小于7.00。我们研究了脐动静脉血气差异是否能更好地预测与窒息相关的并发症。
研究对象包括82例足月、无畸形、单胎、活产且患有严重脐酸中毒（pH < 7.00）的婴儿。脐动静脉pH值、PCO2和PO2差值与阿氏评分以及新生儿期癫痫发作、缺氧缺血性脑病、心肺和肾功能障碍及发育异常的发生情况相关。
脐动静脉pH值、PCO2和PO2差值相互关联（p < 0.0001），但这些参数与1分钟和5分钟阿氏评分的相关性较弱。动静脉PCO2差值> 25托是识别患有癫痫发作、缺氧缺血性脑病、心肺和肾功能障碍及新生儿期发育异常的窒息婴儿的高度敏感和特异的参数。动静脉PO2差值在检测新生儿疾病方面不如动静脉PCO2差值敏感。
脐血动静脉PCO2差值为预测围产期窒息足月儿的新生儿疾病和永久性神经损伤提供了一种新工具。
